The importance of proteinuri as determinant of mortality following percutaneous coronary revascularization in diabetics

OBJECTIVES The aims of this study were to compare mortality and clinical events following percutaneous coronary intervention (PCI) between nondiabetics and diabetics with and without proteinuria. BACKGROUND Diabetics have increased rates of late myocardial infarction, repeat revascularization and mortality when compared with nondiabetics following PCI. Proteinuri is marker for diabetic nephropathy and potentially surrogate marker for advanced atherosclerosis. It is unknown if proteinuri is predictor of outcome in diabetics following PCI. METHODS We performed an observational study of 2,784 patients who underwent PCI at the Cleveland Clinic between January 1993 and December 1995. There were 2,247 nondiabetics and 537 diabetics with urinalysis and follow-up dat available (proteinuri n = 217, nonproteinuri n = 320). The diabetic proteinuri group was further prospectively stratified into low concentration (n = 182) and high concentration (n = 35). The end points were all-cause mortality and the composite end point of death, nonfatal myocardial infarction (MI) and need for revascularization. RESULTS The mean follow-up time was 20.2 months. The two-year mortality rate was 7.3% and 13.5% for nondiabetics and diabetics, respectively (p < 0.001). The two-year mortality rate was 9.1% and 20.3% for the nonproteinuri and proteinuri groups, respectively (p < 0.001). There was graded increase in mortality comparing the diabetic group. The two-year mortality rate was 9.1%, 16.2% and 43.1% for the nonproteinuria, low concentration and high concentration groups, respectively (p < 0.001). The difference in survival between the nondiabetic and nonproteinuric diabetics was not significant (p = 0.8). CONCLUSIONS The presence of proteinuri is the key determinant of risk following PCI for diabetics. Diabetics without evidence of proteinuri have similar survival compared with nondiabetics.